592例食管癌3DRT的预后分析

目的 分析食管癌3DRT (3DCRT、IMRT)疗效和预后影响因素。方法 2002—2012年间本院接受3DRT食管癌患者592例,其中3DCRT者123例、IMRT 者469例,单纯放疗360例、放化疗232例。中位放疗剂量60 Gy。Kaplan-Meier法计算OS、PFS并Logrank法检验和单因素预后分析,Cox法多因素预后分析。结果 3、5年样本数分别为142、53例。1、3、5年OS和PFS率分别为65.3%、34.0%、23.5%和52.1%、28.0%、19.6%。中位OS时间20个月(95%CI为17.9~22.1个月),中位PFS时间14个月(95%CI为11.8~16.2个月)。单因素分析显示影响OS和PFS因素有性别、N分期、M分期、TNM分期、放疗剂量、治疗前体重下降、吸烟和饮酒(P=0.002和0.000、0.000和0.000、0.001和0.000、0.000和0.000、0.000和0.000、0.024和0.026、0.009和0.005、0.000和0.000)。多因素分析显示TNM分期、放疗剂量和性别是影响OS、PFS因素(P=0.000和0.000、0.000和0.001、0.036和0.027)。结论 食管癌3DRT的生存有所提高,临床TNM分期、放疗剂量和性别是影响生存的因素。

Analysis of outcomes and prognostic factors in 592 esophageal cancer patients treated with three-dimensional radiotherapy

Objective To summarize the outcomes and prognostic factors in esophageal cancer (EC) patients treated with three-dimensional radiotherapy (3DCRT and IMRT). Methods Five hundred ninety-two EC patients received three-dimensional radiotherapy (123 with 3DCRT, 469 with IMRT) in our hospital from January 2002 to March 2012. Three hundred and sixty patients received radiotherapy alone and 232 patients received radiotherapy and chemotherapy. The median radiotherapy dose was 60 Gy. Concurrent chemotherapy was used with paclitaxel plus platinum (weekly schedule). Sequential chemotherapy was used with paclitaxel or fluorouracil plus platinum (3-week schedule). The Kaplan-Meier method was used to calculate overall survival (OS) and progression-free survival (PFS), and the log-rank test was used for survival difference analysis and univariate prognostic analysis. The Cox regression model was used for multivariate prognostic analysis. Results The numbers of samples at 3 and 5 years were 142 and 53, respectively. The 1-year OS and PFS were 65.3% and 52.1%, respectively;the 3-year OS and PFS were 34.0% and 28.0%, respectively;the 5-year OS and PFS were 23.5% and 19.6%, respectively. The median OS was 20 months (95% CI:17.9-22.1 months) and the median PFS was 14 months (95% CI:11.8-16.2 months). Univariate analysis indicated that sex, N stage, M stage, TNM stage, radiotherapy dose, weight loss before treatment, smoking, and drinking were prognostic factors for OS and PFS (P=0.002 and 0.000,0.000 and 0.000,0.001 and 0.000,0.000 and 0.000,0.000 and 0.000,0.024 and 0.026,0.009 and 0.005,0.000 and 0.000). Multivariate analysis showed that TNM stage, radiotherapy dose, and sex were prognostic factors for OS and PFS (P=0.000 and 0.000,0.000 and 0.001,0.036 and 0.027). Conclusions The outcomes of EC patients treated with three-dimensional radiotherapy alone or combined with chemotherapy are promising. Early TNM stage, high radiotherapy dose, and female sex are independently associated with better OS and PFS.